Cataracts

Though the procedure is very safe and effective, some doctors recommend needless tests or push newer types of lenses that pose risks.

Skip unneeded presurgery tests. Cataract surgery, usually performed as an outpatient procedure, requires only a local anesthetic to numb your eye.

Research shows that for most people the only pre-op requirements are that you be free of infection and have normal blood pressure and heart rate. Yet many doctors routinely order other tests, including blood counts and electrocardiograms, as would be necessary before a major procedure. That’s overkill, according to the American Academy of Ophthalmology.

Those tests can come with high co-pays and lead to false alarms that may delay surgery or force you to undergo additional tests, such as a chest X-ray or an ultrasound. So ask whether your doctor plans to recommend such tests and, if so, whether you can skip them.

Be wary of premium lenses. In standard cataract surgery, doctors remove the clouded lens and replace it with an artificial monofocal lens, which provides clear images at either near or far vision. There are multifocal lenses that do both, so you don’t also have to wear glasses.

But multifocal lenses cost up to $4,000—and usually aren’t covered by insurance. More worrisome, a 2012 review found that while the lenses provided better near vision, they also produced more complaints of halos and glare. Other research shows that people with multifocal lenses are also more likely to need repeat surgery.

One time you might consider a premium intraocular lens: if you have an astigmatism, or an irregularly shaped cornea.

Special lenses, called toric lenses, can correct that problem, says David Sholiton, M.D., an ophthalmologist at the Cleveland Clinic. And studies reveal that most people who get them are satisfied. But you will probably have to pay $1,000 or more out of your own pocket because insurance rarely covers them.

Glaucoma

More than 2.2 million Americans have glaucoma, but only half know it. That makes screening important.

Treatment is key, too, because glaucoma can lead to permanent vision loss. But treatment, which often requires several different daily eye drops, can be expensive and complicated.

Get the right tests. Glaucoma often goes undiagnosed because it causes no symptoms until vision declines, at which point treatment no longer helps. So people ages 40 to 60 should consider being examined by an ophthalmologist or optometrist every three to five years; those older than 60 need an eye exam every one to two years.

Know you may need more than one test. Though many eye doctors screen for the disease with tonometry—a test that measures eye pressure—that’s not enough. Relying only on intraocular pressure when screening for glaucoma could miss up to half of all cases, research suggests, says ophthalmologist Andrew Iwach, M.D., executive director of the Glaucoma Center of San Francisco.

So the exam should also include an ophthalmoscopy, which involves examining your optic nerve. If you have elevated eye pressure but no other signs of glaucoma, you might not need to start treatment, which can be expensive. Instead, your doctor might screen you more often.

Go for generics. The most common treatment for glaucoma is eye drops known as prostaglandin analogs (PGAs), which lower eye pressure. Generic versions of most of those drugs are much cheaper than the brand-name versions. And per­haps because of the lower cost, patients taking them tend to do a better job of using the drops on schedule, which is important, according to an April 2015 study in the journal Ophthalmology.

Know you may need more than one drug. Many people need several drugs to control glaucoma, which usually means adding a beta-blocker drop. In that case, ask your doctor about drugs that combine medications, minimizing the number of drops.

Use proper eye drop technique. Tilt your head back and pull down the lower lid with your finger to form a pocket. Hold the dropper tip close to the eye without touching it, and squeeze one drop into the pocket. Close your eye for 2 to 3 minutes, tip your head down, and gently press on the inner corner of the eye. Try not to blink. If you need more than one drop in the same eye, wait at least 5 minutes between drops to let the first drop absorb.

Macular Degeneration

Age-related macular degeneration, a leading cause of vision loss in the U.S. for people 50 and older, damages the macula, the small area near the center of your retina, causing vision loss in the center of your visual field.

The advanced disease comes in two main forms: dry AMD, the more common variety, which is treated mainly with dietary supplements; and wet AMD, the more serious form, which requires monthly injections from an ophthalmologist with one of three drugs. There are controversies about both the supplements and the drugs.

Get the right supplement. Research funded by the National Institutes of Health has shown that a specific blend of vitamins and minerals known as AREDS (vitamins C and E, plus copper, lutein, zeaxanthin, and zinc) cuts the risk—by about 25 percent—that dry AMD will progress.

“It’s really the only treatment,” says Neil Bress­ler, M.D., chief of the retina division at Johns Hopkins University in Baltimore.

But not all eye supplements contain the proper formulation.

In January 2015, CVS was sued for incorrectly market­ing its Advanced Eye Health supplement as comparable to the formula used in published studies. And in an analysis of 11 eye-health supplements in the March 2015 issue of Ophthalmology, only four contained the right mix: PreserVision Eye Vitamin AREDS Formula, PreserVision Eye Vitamin Lutein Formula, PreserVision AREDS2 Formula, and ICAPS AREDS.

Be wary if your doctor suggests a genetic test to determine which supplement is best for you. Remember: The supplements have been shown to help treat only people diagnosed with AMD. Don’t bother taking any supplement with the hope that it will prevent the disease.

Consider inexpensive drugs. Each of the three drugs used to treat wet AMD—aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis)—work equally well in slowing vision loss.

But Avastin costs just $50 per month, compared with $2,000 for the others. So experts recommend Avastin as the first choice for most people with wet AMD. But some doctors resist that advice.

First, Avastin is officially approved only as a cancer drug and doesn’t come in appropriate doses for AMD. So doctors need to get the medicine from a compounding pharmacy, which combines, alters, or—in this case—repackages ingredients. That poses some risk of contamination, and there have been reports of people being harmed by bacteria that got into Avastin. So some doctors, especially those without access to a reliable compounding pharmacy, may hesitate to prescribe the drug.

Some other physicians may have a financial reason for skipping Avastin: Medicare reimburses doctors less for it. That might help your doctor’s wallet, but it can hurt yours: People without supplemental Medicare may pay up to $400 out of pocket for Lucentis, compared with just $10 for Avastin.

Our advice: Consider Avastin, especially if you don’t have supplemental Medicare coverage. But ask whether your doctor’s compounding pharmacy is accredited by the Pharmacy Compounding Accreditation Board, which means it must adhere to quality standards.

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For years now, NASA has been puzzled by a mysterious effect of extended space flight: vision damage. Many, though not all, astronauts who have been in space for months at a time experienced their vision slowly degrading, and post-flight inspection revealed that the back of their eyeballs had been squished down and flattened over the course of their trip.

But new research presented this week provides a partial answer to what’s causing this condition: pressurized spinal fluid. Noam Alperin, a researcher at the University of Miami’s Evelyn F. McKnight Brain Institute, presented findings from research he and his peers conducted on 16 astronauts, measuring the volume of cerebrospinal fluid (CSF) in their heads before and after spaceflight. CSF floats around the brain and spine, cushioning it and protecting your brain as you move, such as when you stand up after lying down.

Alperin and his team found that astronauts who had been in space for extended trips (about six months) had much higher build up of CSF in the socket around the eye than astronauts who had only gone on short stints (about two weeks). They also designed a new imaging technique to measure exactly how “flat” the astronauts eyeballs had become after extended periods in space.

The idea is that, without the assistance of gravity, the fluid isn’t pulled down and evenly distributed, allowing it to pool in the eye cavity and build up pressure, which slowly starts to warp the eye and cause the vision damage, called visual impairment intracranial pressure syndrome (VIIP). It’s likely some people are more predisposed to this than others, perhaps due to the shape of their skulls, which would explain why some astronauts have not experienced VIIP. But Alperin said his findings suggest anybody could get VIIP if they’re in space for a long enough period of time.

“We saw structural changes in the eye globe only in the long-duration group,” Alperin told me over the phone. “And these changes were associated with increased volumes of the CSF. Our conclusion was that the CSF was playing a major role in the formation of the problem.”

The results have not been published in a peer-reviewed journal, but Alperin told me the manuscript was recently accepted and will be published shortly. And these reported findings align with what scientists already suspected about the condition, according to Scott M. Smith, the manager of NASA’s Nutritional Biochemistry Laboratory at the Johnson Space Center, who’s been studying the vision loss issue for the last six years.

“I think this fits very well within what others seem to be thinking at the moment,” Smith told me.

Many astronauts—though, importantly, not all—have experienced this unexplained reduction in eyesight after spending months on the International Space Station, some dropping from perfect 20/20 vision to 20/100 in just six months. Researchers have been gravely concerned about this effect. With plans to send humans to Mars by the 2030s, a mission that would require nine months of space flight one way, we don’t really want to risk all of our astronauts going blind in the process.

“NASA ranks human health risks and the two top risks are radiation and vision issues,” Smith said. “Is it number one or two? Some people would say it’s number one, because we don’t really know what the long-term implications are.”

But the better we understand how VIIP occurs, the more likely we are to be able to create a solution. Smith’s team is currently conducting a clinical trial to investigate whether polycystic ovarian syndrome—which, despite its name, may indeed occur in men—could have similar effects on vision. This research could help explain who is more likely to experience VIIP, as research like Alperin’s explores the physical functions of the condition.

What a solution to the condition will look like depends what else we learn: it could be a medication, or a mechanical device to help redistribute fluid, or something else entirely. But each piece to the puzzle helps us get one step closer to sending humans to Mars, and not blinding them in the process.

In the classic 1930s movie, “The Wizard of Oz,” Dorothy asks the good citizens of Oz whether they could dye her eyes to match her gown, and they happily oblige. Of course, eyes are not like hair, and 75 years on you still cannot dye your eyes to suit your outfit. But it turns out that you can actually change their color with the aid of a laser. The technique was pioneered by California-based Stroma Medical and it is currently available in several countries, but it has yet to receive approval in the United States. So far, 37 patients in Mexico and Costa Rica have undergone the procedure, which permanently turned their eyes from brown to blue. If you fancy twinkling blue eyes yourself, you had.

So far, 37 patients in Mexico and Costa Rica have undergone the procedure, which permanently turned their eyes from brown to blue. If you fancy twinkling blue eyes yourself, you had best start saving your pennies as the procedure will set you back around $5,000 (£3,300). Those who don’t fancy breaking the bank are probably happy enough using colored contact lenses. So how does it work? It actually doesn’t involve adding any color to the eye—blue eyes are not this shade because of blue pigments, but rather the scattering of light. In blue-eyed people, when multicolored light falls on the eye, it is mostly the blue wavelengths that are reflected back and picked up by our own eyes. The difference with brown-eyed individuals is that the front layer of their eyes, called the stroma, contains an abundance of melanin, the pigment that also gives skin and hair their color.

This results in the majority of light hitting the eye being absorbed, but the small amount reflected makes them appear brown to us. So to go from brown to blue, all you need to do is remove the melanin present in the iris. Stroma Medical’s chairman Dr. Gregg Homer explained to CNN how it works: “The fundamental principle is that under every brown eye is a blue eye. The only difference between a brown eye and a blue eye is this very thin layer of pigment on the surface.

If you take that pigment away, then the light can enter the stroma—the little fibers that look like bicycle spokes in a light eye—and when the light scatters it only reflects back the shortest wavelengths and that’s the blue end of the spectrum.” According to Homer, the laser procedure takes just 20 seconds, although the results won’t be apparent for several weeks as it takes time for the body to remove the dead pigment layer. While the go-ahead has not yet been given to perform the technique in the U.S., preliminary studies have suggested that it is safe, but it will take several years for the clinical trials to reach completion.

Experts in the field have raised their eyebrows about its safety, however, with some suggesting that the pigment could cause a blockage in draining channels, which may increase pressure in the eye, ultimately leading to glaucoma if not resolved. But Homer counters this argument by pointing out that the debris resulting from the procedure would be too small to cause such problems. Although the procedure is fairly pricey, it’s easy to see that there would be a high demand. Only 17% of the world’s population has blue eyes and they are becoming less common. Would you go for it?

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Prolonged exposure to the sun’s ultraviolet A (UV-A) rays has long been associated with increased risk for cataracts and skin cancer.

For many Americans who drive each day, their car’s front windshield protects them from the harmful rays. Findings of a new study, however, revealed that car door windows do not offer the same protection from the sun.

In a new research published in JAMA Ophthalmology on May 12, Brian Boxer Wachler, from the Boxer Wachler Vision Institute, analyzed the UV protection provided by glass in 29 cars that were produced between 1990 and 2014.

The researcher measured the levels of ambient UV-A radiation behind the cars’ front windshield and the side window and found that the windshield windows tend to provide good protection blocking 96 percent of UV-A rays on average. The protection, however, was lower at 71 percent and inconsistent for the cars’ side windows.

The research likewise revealed that only 14 percent of the cars have side windows that provide high level of UV-A protection, which could be to blamed in part for the increased prevalence of skin cancer on the left side of people’s faces and left-eye cataracts.

Based on his findings, Wachler said that automakers may want to consider boosting the amount of UV-A protection in the side windows of vehicles.

“Auto glass with UV-A protection would be expected to reduce the risks of disorders related to sun damage,” Wachler wrote in his study.

Jayne Weiss, from the Louisiana State University Eye Center of Excellence, explained that windshields provide more protection than car door windows because they are made of laminated glass designed to prevent shattering. The car door windows, on the other hand, are only tempered glass.

“Don’t assume because you are in an automobile and the window is closed that you’re protected from UV light,” Weiss said.

Although UV-B rays can be blocked by glass, UV-A is a longer wavelength of light that can go deeper into the skin and this can cause premature aging and even skin cancer.

Experts recommend using sunglasses that block both UV-B and UV-A lights as well as using long sleeve clothing and broad spectrum sunscreen particularly during long drives on sunny days. Drivers with older cars or those whose cars don’t have built-in protection can also buy special window tint products that provide shield against UV rays.

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Do you think you have full control over deciding whether to trust someone or not? Guess again!

Among the visual cues we use for non-verbal communication, there’s the usual suspects like body language and facial expressions. They govern much of how we feel about each other, and can be both voluntary and involuntary. But there’s one thing we do when encountering new people that we have absolutely no control over, and that we mostly don’t even notice. It’s all in the eyes – or rather, the pupils.

Researchers in the Netherlands performed an eye-tracking study among 69 university students to see if our eyes held the key to establishing trust.

The participants were shown a short video of someone’s face looking straight at them, and then given the (hypothetical) choice to transfer money to this virtual partner. The experiment was set up to allow participants to judge the trustworthiness of each virtual partner in a very short amount of time.

More pupil-mimicry meant higher donations

The eye-tracking results showed that the participants would closely mimick the behaviour of their partner’s pupils, contracting and dilating along with them – or staying perfectly still.

Interestingly, the scientists found that the students to mimicked their partners’ pupils most were also most likely to donate money to said partners. This indicates that pupil tracking plays a significant role in determining whether to trust someone.

Here’s one stare you won’t be able to mimick.

We mimick each other all the time

Adopting another’s stances and features isn’t unheard of in communication. Apart from linguistic features we perform without realising it, such as accomodating your conversation partner by adapting your word choice and tone of voice to the person and situation, there are also non-verbal things we do to “establish rapport” with someone we’re speaking to:

Mimicry is common in social interactions. We establish rapport by adopting another’s postures, facial expressions and even heartbeat. “In emotion research, there’s a lot of focus on facial expressions,” Kret says. “Given that we spend so much time looking at each other’s eyes, I think we can learn a lot more from the pupils.”

There may be a lot we don’t yet understand about human interaction, and research like this can give us vital information about the things we do every day, like engaging in conversation.

We can only hope that insights like the one from this study won’t end up being used to manipulate people in things like advertising. I wouldn’t be at all surprised if pilot studies are already underway to try to get some practical application of this effect going.